| NPI | 1164590279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TX PA02562) |
| Additional Taxonomies | 163WM0705X Registered Nurse, Medical-Surgical (Licence: TX 556120) |
| 363AM0700X Physician Assistant, Medical (Licence: TX PA02562) | |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2019-01-14 |